Osteochondral Lesions

Osteochondral Lesions: Microfracture vs Reconstruction

Osteochondral lesions can be treated by Microfracture or by Allograft Reconstruction for larger lesions
Occur as a result of ankle sprains and fractures
Ankle inversion and dorsiflexion during axial load creates shearing of lateral talar dome and lateral OLT
Ankle inversion, external rotation, and plantarflexion during axial load creates shearing of medial talar dome and medial OLT

Requires live allograft donor tissue and a medial malleolar osteotomy of the ankle

You will have a plaster cast on your ankle and foot for 2 weeks following surgery
An aircast will be applied at 2 weeks
If you have a MICROFRACTURE you will begin WB at 2 weeks
At 6-8 weeks, you will begin walking on the aircast if you have a RECONSTRUCTION and at 12 weeks the aircast will be removed

The surgical incision has been closed with sutures
Do not get the cast or wound wet for the first two weeks. When showering place a bag over the cast and secure with tape to your leg to avoid the cast and wound getting wet
Stitches will be removed at your 2 week appointment
After the stitches are removed, you may begin to shower after 2-3 days
Do not immerse the foot in water (bath, hot tub, pool) for 4 weeks
Do not apply any lotions or creams on the wound for 6 weeks

You will be non weight bearing for 2 weeks with a MICROFRACTURE
You will be non weight bearing for the first 6 weeks while in an aircast following a RECONSTRUCTION
You will use a mobility device to offload your foot (crutches, walker, stirrup cast)
After 6-8 weeks you may begin fully walking on the foot with a RECONSTRUCTION

You will be given a prescription for pain medication
Pain medication should be used regularly for the first 24-48 hours, when required for the first 1 to 2 weeks, followed by Regular ibuprofen
Aspirin may be prescribed as a blood thinner

For right foot surgery you are not permitted to drive until you have completely weaned off the aircast
For left foot surgery, please contact your insurance company to see if you are permitted to drive
Driving is not permitted while on narcotics

Two weeks off work is recommended for initial recovery
If you can be transported to work and you have a sedentary occupation you may return to work when you are able and are off narcotics
From 2-8 weeks sedentary duties is recommended
By 12 weeks you can gradually return to full duties
If your job is physically demanding, return to full duties is usually possible around 12 weeks post operatively

You will have your first appointment 2 weeks after surgery in the Fracture Clinic
Your next appointments will be at 6 weeks, 3 months then 6 months post operatively

It is normal to experience mild to moderate pain, numbness, or tingling for the first 2 weeks following surgery
You will get back to most of your activities by 6-12 months
Swelling often remains for 6-12 months
You are expected to experience a FULL recovery (no pain, no swelling, ability to walk, etc.) in 9-12 months

Six weeks after surgery you will be referred for physiotherapy (Physiotherapy protocol)